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Article

Long-Term Clinical Outcomes of Left Atrial Appendage Closure in Patients with Left Atrial Appendage Thrombus

by
Moshe Katz
1,2,*,†,
Rotem Nahmias Oz
1,†,
Eias Massalha
1,2,
Avi Sabag
1,2,
Eyal Nof
1,2,
Israel Barbash
1,2,
Paul Fefer
1,2,
Victor Guetta
1,2 and
Roy Beinart
1,2
1
Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
2
Cardiology Department, Sheba Medical Center, Tel-Hashomer, Ramat Gan 5262000, Israel
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
J. Clin. Med. 2025, 14(21), 7589; https://doi.org/10.3390/jcm14217589
Submission received: 24 September 2025 / Revised: 18 October 2025 / Accepted: 22 October 2025 / Published: 26 October 2025
(This article belongs to the Topic Epidemiology of Atrial Fibrillation: Trends, Insights, and Global Challenges)
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Abstract

Background: Patients with atrial fibrillation (AF) who have a high bleeding risk or contraindications to anticoagulation may be candidates for left atrial appendage closure (LAAC). However, the presence of a thrombus in the left atrial appendage (LAA) is generally considered a contraindication to the procedure. While the feasibility and short-term safety of LAAC in patients with pre-existing LAA thrombus has been reported, data on long-term outcomes remain limited. Objective: To assess the long-term clinical outcomes of AF patients undergoing LAAC in the presence of an LAA thrombus. Methods: This retrospective, single-center registry included all AF patients who underwent LAAC between June 2010 and April 2024. Patients were stratified based on the presence or absence of LAA thrombus at the time of the procedure. The primary endpoint was a 5-year composite of stroke, systemic embolism, or all-cause mortality. Results: A total of 403 patients underwent LAAC, of whom 24 (6%) had an LAA thrombus at the time of the procedure. During a median follow-up of 3.9 years, the primary endpoint occurred in 116 patients: 110 events (41%) in the no-thrombus group and 6 events (38%) in the thrombus group. There was no statistically significant difference in major adverse cardiovascular events (MACE) between groups (log-rank p = 0.862). Conclusions: LAAC may be performed safely in selected patients with distal LAA thrombus, with long-term outcomes comparable to those without thrombus.
Keywords: atrial fibrillation; left atrial appendage; atrial thrombus; stroke; systemic embolism atrial fibrillation; left atrial appendage; atrial thrombus; stroke; systemic embolism

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MDPI and ACS Style

Katz, M.; Nahmias Oz, R.; Massalha, E.; Sabag, A.; Nof, E.; Barbash, I.; Fefer, P.; Guetta, V.; Beinart, R. Long-Term Clinical Outcomes of Left Atrial Appendage Closure in Patients with Left Atrial Appendage Thrombus. J. Clin. Med. 2025, 14, 7589. https://doi.org/10.3390/jcm14217589

AMA Style

Katz M, Nahmias Oz R, Massalha E, Sabag A, Nof E, Barbash I, Fefer P, Guetta V, Beinart R. Long-Term Clinical Outcomes of Left Atrial Appendage Closure in Patients with Left Atrial Appendage Thrombus. Journal of Clinical Medicine. 2025; 14(21):7589. https://doi.org/10.3390/jcm14217589

Chicago/Turabian Style

Katz, Moshe, Rotem Nahmias Oz, Eias Massalha, Avi Sabag, Eyal Nof, Israel Barbash, Paul Fefer, Victor Guetta, and Roy Beinart. 2025. "Long-Term Clinical Outcomes of Left Atrial Appendage Closure in Patients with Left Atrial Appendage Thrombus" Journal of Clinical Medicine 14, no. 21: 7589. https://doi.org/10.3390/jcm14217589

APA Style

Katz, M., Nahmias Oz, R., Massalha, E., Sabag, A., Nof, E., Barbash, I., Fefer, P., Guetta, V., & Beinart, R. (2025). Long-Term Clinical Outcomes of Left Atrial Appendage Closure in Patients with Left Atrial Appendage Thrombus. Journal of Clinical Medicine, 14(21), 7589. https://doi.org/10.3390/jcm14217589

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